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Youth Application [PHONE REDACTED] Printing Exploring is based on a unique and dynamic relationship between youth and the organizations in their communities. Local community organizations initiate a specific Explorer post or club by matching their people and program resources to the interests of young people in the community. The result is a program of activities that helps youth pursue their special interests, grow, and develop. Explorer posts/clubs can specialize in a variety of career skills. Exploring programs are based upon five areas of emphasis: career opportunities, life skills, citizenship, character education, and leadership experience. The Exploring Learning for Life career education program is for young men and women who are at least 14 (and have completed the eighth grade) or 15 years of age but not yet 21 years old. Exploring’s purpose is to provide experiences to help young people mature and become responsible and caring adults. Explorers are ready to explore the meaning of interdependence in their personal relationships. For Sixth-, Seventh-, and Eighth-Graders The Explorer Club Learning for Life career education program is for young men and women who are in the sixth, seventh, and eighth grades. The Explorer Club’s purpose is to provide experiences to help young people learn about different careers. ---PAGE BREAK--- SAMPLE First name (No initials or nicknames) Middle name Last name Suffix K A T H L E E N J A N E S M I T H Number: Name and address information (Please print one letter in each space—press hard, you are making a copy.) Participation fee $ . Country Mailing address City State Zip code 1 2 3 4 A N Y S T R E E T A N Y t o w n n y 1 2 3 4 5 U S School o a k t r e e H I G H S C H O O L Gender: Male Female Use black or DARK blue ink only. I have read the attached information sheet and approve the application (signature of parent/guardian required if applicant is under 18 years of age). Date 0 5 / 1 3 / 2 0 1 3 Bill Taylor Signature of post or club leader Signature of parent/guardian Deborah Sue Smith Signature of Explorer Kathy Smith Youth Participant Retain on file for three years. 524-009 Black/African American Caucasian/White Native American Hispanic/Latino Alaska Native Pacific Islander Asian Other Phone Date of birth (mm/dd/yyyy) Grade Ethnic background: 5 5 5 - 1 2 3 - 4 5 6 7 0 1 / 0 1 / 1 9 9 8 1 0 • Parent/guardian information First name (No initials or nicknames) Middle name Last name Suffix d e b o r a h s u e s m i t h Business phone Ext. Previous Exploring experience Cell phone 5 5 5 - 7 6 5 - 4 3 2 1 X F I R E E X P L O R E R 5 5 5 - 2 5 3 - 6 1 1 8 Parent/guardian email address Country Mailing address City State Zip code 1 2 3 4 a n y s t r e e t a n y t o w n n y 1 2 3 4 5 U S Home phone Date of birth (mm/dd/yyyy) Occupation Employer Gender: M F V P O P E R A T I O N R G K I N T L 5 5 5 - 1 2 3 - 4 5 6 7 0 1 / 0 1 / 1 9 7 2 • Select relationship: Parent Guardian Grandparent Other (specify) Exploring Post Explorer Club • • D E B 0 R A H . S M I T H @ @ Paid: Cash Check No. Credit card Email address (Post youth participant only) K A T H Y J S @ M Y M A I L . C O M Tips for completing the Application for Exploring Youth Participant: Print—do not use cursive. Use black or dark blue ink. Press firmly when printing. Print one letter only in each box. Use uppercase letters and stay within the blue boxes for legibility. Fill in circles; do not use check marks. Make sure you have all needed signatures on application. Don’t alter the application—it could affect the quality of the scan. Mailing address example: 7 0 3 F I R S T S T Participant Chart Term per month Youth/adult participant fee 1 2.00 2 4.00 3 6.00 4 8.00 5 10.00 6 12.00 7 14.00 8 16.00 9 18.00 10 20.00 11 22.00 12 24.00 13 26.00 14 28.00 15 30.00 16 32.00 17 34.00 18 36.00 TEMPORARY Participant CERTIFICATE (Good for 60 days) This certifies that is a member of Post or club leader signature Date Cut along dotted line. • Print—do not use cursive. • Print one letter or number only in each box. • Use uppercase letters and stay within the blue boxes for legibility. • Fill in radio buttons completely. • Make sure you have all needed signatures on application. ---PAGE BREAK--- Youth Participant Parent/guardian information Select relationship: Black/African American Caucasian/White Native American Hispanic/Latino Alaska Native Pacific Islander Asian Other I have read the attached information sheet and approve the application (signature of parent/guardian required if applicant is under 18 years of age). First name (No initials or nicknames) Middle name Last name Suffix Number: Phone Date of birth (mm/dd/yyyy) Grade Ethnic background: - - / / School First name (No initials or nicknames) Middle name Last name Suffix Business phone Ext. Previous Exploring experience Cell phone - - X - - Parent/guardian email address Home phone Date of birth (mm/dd/yyyy) Occupation Employer Gender: M F - - / / Date / / If applicant has an unexpired participant certificate, participation may be accomplished at no charge by transferring the registration. Mark and attach a copy of the certificate. Name and address information (Please print one letter in each space—press hard, you are making a copy.) Retain on file for three years. Gender: Male Female Participation fee $ . Country Mailing address City State Zip code U S Country Mailing address City State Zip code U S Parent Guardian Grandparent Other (specify) 524-009 @ Paid: Cash Check No. Credit card Transfer application Transfer from council no.: Number: Email address (Post youth participant only) @ Exploring Post Explorer Club Exploring Post Explorer Club Signature of post or club leader Signature of Explorer Signature of parent/guardian LOCAL office COPY ---PAGE BREAK--- ---PAGE BREAK--- Youth Participant Parent/guardian information Select relationship: Black/African American Caucasian/White Native American Hispanic/Latino Alaska Native Pacific Islander Asian Other I have read the attached information sheet and approve the application (signature of parent/guardian required if applicant is under 18 years of age). First name (No initials or nicknames) Middle name Last name Suffix Number: Phone Date of birth (mm/dd/yyyy) Grade Ethnic background: - - / / School First name (No initials or nicknames) Middle name Last name Suffix Business phone Ext. Previous Exploring experience Cell phone - - X - - Parent/guardian email address Home phone Date of birth (mm/dd/yyyy) Occupation Employer Gender: M F - - / / Date / / If applicant has an unexpired participant certificate, participation may be accomplished at no charge by transferring the registration. Mark and attach a copy of the certificate. Name and address information (Please print one letter in each space—press hard, you are making a copy.) Retain on file for three years. Gender: Male Female Participation fee $ . Country Mailing address City State Zip code U S Country Mailing address City State Zip code U S Parent Guardian Grandparent Other (specify) 524-009 @ Paid: Cash Check No. Credit card Transfer application Transfer from council no.: Number: Email address (Post youth participant only) @ Exploring Post Explorer Club Exploring Post Explorer Club Signature of post or club leader Signature of Explorer Signature of parent/guardian POST OR CLUB COPY ---PAGE BREAK--- ---PAGE BREAK--- Youth Participant Parent/guardian information Select relationship: Black/African American Caucasian/White Native American Hispanic/Latino Alaska Native Pacific Islander Asian Other I have read the attached information sheet and approve the application (signature of parent/guardian required if applicant is under 18 years of age). First name (No initials or nicknames) Middle name Last name Suffix Number: Phone Date of birth (mm/dd/yyyy) Grade Ethnic background: - - / / School First name (No initials or nicknames) Middle name Last name Suffix Business phone Ext. Previous Exploring experience Cell phone - - X - - Parent/guardian email address Home phone Date of birth (mm/dd/yyyy) Occupation Employer Gender: M F - - / / Date / / If applicant has an unexpired participant certificate, participation may be accomplished at no charge by transferring the registration. Mark and attach a copy of the certificate. Name and address information (Please print one letter in each space—press hard, you are making a copy.) Retain on file for three years. Gender: Male Female Participation fee $ . Country Mailing address City State Zip code U S Country Mailing address City State Zip code U S Parent Guardian Grandparent Other (specify) 524-009 @ Paid: Cash Check No. Credit card Transfer application Transfer from council no.: Number: Email address (Post youth participant only) @ Exploring Post Explorer Club Exploring Post Explorer Club Signature of post or club leader Signature of Explorer Signature of parent/guardian explorer COPY/receipt ---PAGE BREAK---